38B-084-002 BP-2024-0649
136 SOUTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
388-084-002 CITY OF NORTHAMPTON
Permit: Alta Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-0649 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2024 Contractor: License:
Est.Cost: 3000 HOMEWORKS ENERGY INC 106148
Const.Class: Exp.Date: 07/30/2024
Use Group: Owner: TRUSTEE GRIGGS, RUTH
Lot Size(sq.ft.)
Zoning. URB Applicant: HOMEWORKS ENERGY INC
Applicant Address Phone: Insurance:
235 ESSEX ST 781-205-4484 1847910
WHITMAN, MA 02382
ISSUED ON: 05/22/2024
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI ZATI ON
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimne :
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.Signature: 7l
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
FEE: $65.00 13I. J.,--F OM Please email Permit to WXPermitting@homeworksenergy.com
- _ Deppo
► R�:r �- City of Northampto,h___.-. E�� �
Building Department
212 Main Street INSULA TION MaY 212024
Room 100
�fNorthampton, MA 0 60 J 413-587-1240 Fax dq4- 670r ,NSPFc,, ONLY
> phone 'No THA - nN;s
nmron.MAo�n: ,
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 -SITE INFORMATION INSULATION PERMIT
1.1 Property Address: This section to be completed by office
Map Lot Unit
(Unit 13 6) 136 South St Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ruth Griggs (Unit 136) 136 South St
Name(Print) Current Mailing Address:
See Attached 9143294682
Teelephlephone
Signature
2.2 Authorized Agent:
Adam Glenn 71 Dudley Rd Sutton MA 01590
Name(Print) i;:ez,e)- Current Mailing Address:
781-205-4516
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to he Official Use Only
completed by permit applicant
1. Building 3000 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee 6/
4. Mechanical (HVAC) 4
5. Fire Protection 6. Total = (1 +2+3+4+5) 3000 Check Number /4t7r
9
J / ' L/� This Section For Official Use Only
Building Permit Number: ," `7 71'' "/ Date
6
Issued:
Signature: // -,7-20 Zl
Building Commissioner/Inspector of Buildings Date
wxpermitting @ homeworksenergy.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder Adam Glenn 106148
License Number
71 Dudley Rd Sutton MA 01590 07/30/2024
Addre Expiration Date
781-205-4516
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable
HomeWorks Energy 181138
Company Name Registration Number
71 Dudley Rd Sutton MA 01590 03/02/2025
Address Expiration Date
ca4,,A � Telephone
781-205-4516
SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes { l No ❑
Brief Description of Proposed Work
Residential weatherization/ Air sealing. No structural changes. SITE ID 819756
Adam Glenn , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Adam Glenn
Print Name cdiA, ,$);),eiv.
5/17/24
Signature of Owner/Agent Date
Ruth Griggs , as Owner of the subject
property
hereby authorize HomeWorks Energy
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Attached 5/17/24
Signature of Owner Date
City of Northampton
OatH AAA' Massachusetts4
p' DEPARTMENT OF BUILDING INSPECTIONS' : " x
212 Main Street • Municipal Building
L. Northampton, MA 01060 sstijy `�`'
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work:Weatherization Est. Cost:3000
Address of Work:(Unit 136) 136 South St
Date of Permit Application: 5/17/24
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
5/17/24 Adam Glenn 181138
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,1 hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
j Massachusetts ��'i `''<<G
fly. k DEPARTMENT OF BUILDING INSPECTIONS
\:• K`P 212 Main Street •Municipal Building y ca.
Pe
,w..- Northampton, MA 01060 c3 .N-4 °
o
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
(Unit 136) 136 South St
(Please print house number and street name)
Is to be disposed of at:
McNamara Waste Services LLC, 24 E Longmeadow Rd, Hampden,MA 01036
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
c,jiaA cieteld
5/17/24
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
�{;,,.,i City of Northampton
r.,) �s .I: ;
._
tK Massachusetts * e
ki DEPARTMENT OF BUILDING INSPECTIONS -., W
'iIV r ' 212 Main Street • Municipal Building
.y Northampton, MA 01060
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: (Unit 136) 136 South St
Contractor
Name: HomeWorks Energy
Address: 71 Dudley Road
City, State: Sutton MA 1590
Phone: 781-205-4516
Property Owner
Name: Ruth Griggs
Address: (Unit 136) 136 South St
City, State:
Adam Glenn (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature ,S4lid
Caitaik
Date 5/17/24
i-.IN HOMEENE-03 LLARIVIERE
,4coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
41sttem..----- 1/8/2024
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: tf the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER I CONTACT Lisa Lariviere
Foster Sullivan Insurance Group PHONEtNN FAX
163 Main Street (A/C.No,Eat):(978
) 686-2266 301 (Arc,No):
North Andover,MA 01845 -41 certificates@fostersullivangroup.com
INSURER(S)AFFORDING COVERAGE NAIC X
INSURER A:Kinsale Insurance Company 38920
INSURED INSURER B:The Commerce Insurance Company 34754
Homeworks Energy, Inc INSURER C:Everspan Indemnity Insurance Company 16882
101 Station Landing Suite 110 INSURER D:New Hampshire Employers Insurance Compan 13083
Medford,MA 02155 INSURER E.StarStone Specialty Insurance Company 44776
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY IHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POUCY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD MIND POLICY NUMBER IMM/DDIYYYY) (MM/DD/YYY UMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
CLAIMS-MADE X OCCUR 0100275489 1/1/2024 1/1/2025 DAMAGE TO RENTEDaoccurrencet $ 300,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
POLICY 78i LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER $
B AUTOMOBILE LIABILITY COMBINfEa dEeD SINGLE LIMIT $ 1,000,000
ANY AUTO L15948 1/1/2024 1/1/2025 BODILY INJURY(Per person) $
OWNED SCHEDULED
_ AU TOSS ONLY X AUTNOSyy Ep BODILY INJURY(Per accident) $
X AUTOS ONLY X AUTO ONLY (Pen)aaEccidTenY t�AMAGE $
$
C _ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
X EXCESS LIAB CLAIMS-MADE BR1EI1-000045-00 1/1/2024 1/1/2025 AGGREGATE $ 1,000,000
DED X RETENTION$ 0 $
D WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ECC-600-4001157-2024A 1/1/2024 1/1/2025 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OF(Mandatory
Ma datord in N R EXCLUDED'? N/A E.L.DISEASE-EA EMPLOYEE.$ _
(Mandatory N ) 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
E Pollution U82192240AEM 1/1/2024 1/1/2025 $25k Deductible 1,000,000
A Umbrella-GL Only 0100275711-0 1/1/2024 1/1/2025 Per Occurrence 1,000,000
i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required)
Evidence Only
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Homeworks EnergyInc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
101 Station Landing Ste 110
Medford,MA 02155
AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
�a Department of Industrial Accidents
h t�
Office of Investigations
as . : = Lafayette City Center
- as t:
2 Avenue de Lafayette, Boston, MA 02111-1750
,, www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Homeworks Energy
Address: 71 Dudley Rd
City/State/Zip:Sutton MA 01590 Phone #: 781-205-4516
Are you an employer? Check the appropriate box:
Type of project(required):
1.1] I am a employer with 500+ 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.1=1 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no Weatherization
employees. [No workers' 13.111 Other
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: New Hampshire Employers Insurance Company
Policy#or Self-ins. Lic. #:ECC-600-4001157-2024A Expiration Date: 1/1/2025
Job Site Address: (Unit 136) 136 South St City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify and r the pains and pe4ies of perjury that the information provided above is true and correct
Signature: e..61fted Date: 5/17/24
Phone it: 781-205-4516
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
11:1Board of Health 20 Building Department 3tCity/Town Clerk 4.0 Electrical Inspector 5EI'lumbing
Inspector 6.0Other
Contact Person: Phone#:
til Commonwealth ofMassachusetts
Division of Occupational Licensure Rest:tdcdto.Construction Supervisor Specialty
Boerd of Building Regulations and Standards CSSL-4C ..nsutati7n Contactor
"
Constructir upetlrr�r Specialty
CSSL-106148 Y• ,� .ill. spires: 07/30/2024
ADAM GLENli
19 CHARGE 00 t I ''`
WAREHAM 4 r
o E
1 •
t. failure to possess a current edition of the Massachusetts
*0uvdi: State Rand ng Code is cause for revocation of this license
For inlorrnation about this license
��•.
w rn Call(617) 727-3200 or visit wwass.gov'dpi
Commissioner $2. ( .s,it .u..
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
`+w' I sal!r
v
+'r ,—_=a - Type: Corporation
HOME WORKS ENERGY, INC. 1
1 — --10.11111- .a Registration: 181138
101 STATION LANDING STE 110 ==^; _ Expiration: 03/02/2025
MEDFORD, MA 02155 == -
•o
•G1M tisey
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
181138 0310212025 Boston,MA 02118
HOME WORKS ENERGY,INC.
ADAM GLENSTATION
CAO r� f 1r,,J G��_101 STATION LANDING STE 110 ,qf a -,zGlo/+!" p�"t/ _
MEDFORD, MA 02155
Undersecretary Not valid without signature
HomeWorks Energy
�p a Home Performance Contractor
Ei I I l 101 Station Landing,Medford,
MA 02155 CONTRACT - AUDIT
I- works 781-305-3319
i,(ICl,lYr
CUSTOMER PHONE OATS CUENTI WORK ORDER
Ruth Griggs (914) 329-4682 05/08/2024 819756 60001
SERVICE STREET MANG STREET PROPOSED BY:
136 South Street 136 South St HomeWorks Energy
SERVICE CITY,STATE,ZIP BJLLNG CITY,STATE,ZIP
Northampton, MA 01060 Northampton,MA 01060 Page 1
DESCRIPTION QTY COST INCENTIVE TOTAL
PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 4 $426.36 $426.36
Seal areas of your home against wasteful,excessive air leakage.
Materials to be used to seal your home can include caulks,foams
and other products. Primary areas for sealing include air leakage to
attics,basements, attached garages and other unheated areas
(windows are not generally addressed.)
8 HOURS DUCT SEALING 1 $785.12 $785.12
Provide labor and materials to seal heating and/or cooling ducts
within designated unheated areas. This work will be include
materials and labor.
EXTERIOR DOOR WEATHER STRIPPING 3 $108.96 $108.96
Provide labor and materials to install Q-Ion weatherstripping to
door(s)to restrict air leakage.
DOOR SWEEP 1 $29.66 $29.66
Provide labor and materials to install a doorsweep to restrict air
leakage.
DAMMING 10 $27.80 $20.85 $6.95
Provide labor and materials to install a 12" layer of R-38 unfaced
fiberglass batts for damming purposes.
ATTIC FLOOR OPEN BLOW CELLULOSE 7" 288 $593.28 $444.96 $148.32
Provide labor and materials to install a 7" layer of R-26 Class
Cellulose to open attic space.
HATCH:THERMAL BARRIER POLYISO 2 INCH (ATTIC) 1 $53.96 $40.47 $13.49
Provide labor and materials to insulate the back of an attic hatch with
2" rigid insulation board at R-10.
HomeWorks Energy
�pn r Home Performance Contractor
r I I 101 Station Landing,Medford,MA 02155
9 CONTRACT - AUDIT
works 781-305-3319
CUSTOMER PHONE DATE CLIENT, WORK ORDER
Ruth Griggs (914) 329-4682 05/08/2024 819756 60001
SERVICE STREET BILLING STREET PROPOSED BY:
136 South Street 136 South St HomeWorks Energy
SERVICE CITY,STATE,DP BILLING CITY,STATE.ZIP
Northampton, MA 01060 Northampton,MA 01060 Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
PROPAVENT 2'OR 4' 36 $168.48 $126.36 $42.12
Provide labor and materials to install ventilation chutes in the rafter
bays to maintain air flow.
Total: $2,193.62
Program Incentive: $1,982.74
Deposit: $0.00
Final Total: $210.88
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Two Hundred Ten & 88/100 Dollars $210.88
05/14/2024
COMPANY REPRESENTATIVE CUSTOMER SIGNATURE
05/14/2024
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE
SIGN DATE
30 DAYS.
Insulation/Air Sealing Permit Authorization
Specialist: Andrew LaRoche Company: H omeWorks Energy
Email: andrew.laroche@homeworksenergy.coi Address: 101 Station Landing
Cell: 4136128345 Medford. Ma 02155
Phone: 781.305.3319
MA CSSL- 106148
MA HIC- 181138
Customer: Ruth Griggs Address: 136 South St
Email: ruthgriggs03@gmail.com Northampton, MA, 01060
Site ID: 819756 Phone: 9143294682
I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner
to act on my behalf in obtaining any building permit that maybe required to perform
insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if
one is obtained. Any related permit application cost will come at no additional charge provided that the agreed
Weatherization work is completed.
In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to
have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the
town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete
this process to close out your permit.
Email: ruthgriggs03@gmail.com
Customer
Signature: Date: 5/8/2024
Ruth Griggs
For Condo Owners:
If you have property oversight by a condo associationt, please have the association's authorized person(s) complete and
sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed.
We, being the duly authorized representatives of the association
Name of association or management companyr
or management company have reveiwed the plans and specifications for improvements to the address specified above.
We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out
the proposed work.
Signature of representative Date
Print Name
t Other unit owners may sign when there is no association.
PLAN VIEW
3. Name: f (1jS Site ID: 1 �' Finished Sq. Ft: / ?1�0
, Phone: J� Year of House: Electric Acct#:
.W #Address: }(S._, _ of Floors: a
Gas Acct#:
Nov-i-4 iKa� unit q: #Occupants: / Housing Type? CUh c(n
DUCTWORK INSPECTION Ducts Insulated?❑
Duct linear Ft. •
A)
ilettkqg
Duct Square Ft. L�
Duct Air Sealing Hours 1 ( 1 �/
Duct Insulation �— i� 6IVyyy��� J� \ N
ai
Duct Insulation Removal — m
z BASEMENT INSPECTION qy54A(
i
et
Existing Spec'ing Ln/Sq. Ft.
I
c: Bsmt Wall AG G
?‘(
(�
Crawl Ceiling K, 0
Crawl Rim Joist
•
Bsmt RJ w/Sill
Bsmt RJ NO Sill
. Vapor Barrier s.. -t• ..— . _
•
0. Blower Door? WALLS&GARAGE Drill Location?
Siding Ceil.Height Existing Spec'ing Sq.Ft. Framing
Exterior Wall 1 (.11.-C I c p K' 3'r1yJ1-3 ,(f�JPte "2_ x '—Ix / Balloon or
Exterior Wall 2 x 1 x Balloon rm
Overhang ./ _ / / /
Garage Wall / x x Balloo Platform
Garage Ceiling /J x
x
o
'b Sys V3 ce
1u2E-c 17 ) t'k) ( SW P ,(2,
r :
Insulation Removal
Sqtt.
Sweeps: 3
k WX Stripping:
WORK SPEC'D BUT NOT CONTRACTED .DAD BLOCKS PRESENT? MANDATORY)
Attic Basement/Crawlspace Other: K&T Y/45 oisture Y 4,Combustion Sfty YON
Kneewall Overhang/Garage Asbestos _Y 0 old>100 sq.ft Y 4IP 0 Detector Missing Y filii
Ductwork Exterior Walls Vermiculite Y N Structl Concerns Y N I• her:
Notes for Lead Vendor/Work Not Contracted:
KW WALL AND KW FLOOR Blind Spec? ❑ — OR -------► KW SLOPE AND GABLE END Blind Spec? 0
Why? —
Why?
FRAMING E ntA SPEC'IN>' SO FT, FRAMING EXISTING SPEC'ING SQ.F
WALI. X X _ SLOPE X X
d FLOOR X X GABLE X X pc
� z
O ACCESS X TRANS X X m
U TRANS X X \ ATTIC 2
D
ATTIC SLOPE X x
4-Ft SLOPE X X l 5
EXISTING VENTING?
z EXISTING VENTING? EXISTING PIPES? Y rt'
-
Kwwye^:1nK Ve-;R. OF Hose Dornmm; 5herthlna Actess Temo Access KW Venom Vert BF TlmDAaess
2.
KNEEWALL MANDATORY -
E-s,t( 14)Aact-0.6. et-ev-tA -6., A-1S ► IA.r
0
c o6C, II
1
z— 1 a) NO(S.K
z
36
ci
cc I)) DOKeill
ea X_ (O
u '1a
a
c' Dvcf-
S ql
N . \ $h 6
F) g S
Z
0) tiecleit/ZIO
Insulated Wall X X Reed Utht 0 ins.Hose aF Vent OF LQN Ch,m-E DanminC t2"Root y t Q
Ilajl
AY Handler aH Temp ACCtli TO Poll Doom 05 Hatch a Wall Hatch '/ Door'/ 8'Root lent tity
Vol: X .0058
x x ATTIC 1 Blind Spec? 0 x x ATTIC 2 Spec? 0 X(19 °° I
es12cy)) =
Blind
z Existing Spec'ing Sq ft Existing Specring Sq 13.6(3 story)
6 Unfloored D1� 7- u 0j L Z`6� Unfloored Multipliers
Trusses Dots Batons
N Floored oored
Mixed Insulation Duct Walt
Cath SIO a >6"Loos` None
Cath Slope p Air Sealing Hours
'' Walls Walls
a Access
tl—.. AccessI
Venting Propavents Vent BF BF Hose Dammin, Pro avers nt BF BF Ho Dammin
ois cWHFBox: __ 1
4 ,7'
i 1 r Z /' Temp F'7 I ' I / 1 1 Irnl 1 / I I \ I Front'
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NFA VtntinT) Existin: Ventin_? \e^n^C) 'Roo{t1=
Existing Venting? -►